AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Suboptimal Hypertension Control and Adverse Outcomes in Chronic Aortic Regurgitation
By Zeitoun J, Fakikh Y, Aramouni K et al.
Background: Valve disease guidelines recommend treating hypertension (systolic blood pressure [BP] >140 mmHg) in chronic aortic regurgitation (AR), as systolic hypertension increases left ventricular (LV) afterload. However, control of hypertension in AR can be difficult. The prevalence of suboptimal BP control and its association with LV remodeling and outcomes in AR are not well defined. Current hypertension guidelines recommend BP <130/80 mmHg. Methods: We studied asymptomatic or minimally symptomatic patients with moderate or severe chronic AR on cardiac MRI, preserved LV function, and ≥2 clinical BP measurements after the index study. Exclusions were >mild concomitant valvular disease, prior valve intervention, and congenital disease or shunts. Mean systolic/diastolic BP were calculated from available BP measurements. Suboptimal BP control was defined by mean BP thresholds of ≥140/90 and ≥130/80 mmHg. Associations with LV hypertrophy were evaluated by linear regression. The primary outcome was a composite of death, heart failure hospitalization, or referral for aortic valve replacement (AVR); the secondary outcome was AVR referral. Results: Among 299 patients (median age 67 [55-77] years; 80% male), the median number of BP measurements per patient was 17 [5-41]. Mean BP was ≥140/90 mmHg in 110 (37%) and ≥130/80 mmHg in 198 (66%). Medications were renin-angiotensin inhibitors in 181 (61%), calcium channel blockers in 83 (28%), beta blockers in 125 (42%), and diuretics in 61 (20%); 56 (19%) were on ≥3 agents. Compared with optimal BP, suboptimal BP was associated with higher AR regurgitant volume [43 (33-60) vs 37 (30-51) mL, p=0.002], LV end-diastolic volume index [114 (99-133) vs 108 (83-127) mL/m ² , p=0.047], and LV mass index (LVMi) [85 (74-98) vs 72 (61-90) g/m ² , p<0.001]. Suboptimal BP was associated with higher LVMi in univariable analysis (β=11.07 [5.77-16.36], p<0.001) and after adjustment for regurgitant volume, age, sex, NYHA class, EuroScore II, and LVESV index (β=7.58 [3.28-11.89], p<0.001). Kaplan-Meier analysis showed lower event-free survival with suboptimal BP for both outcomes (log-rank p≤0.007) (Figure 1). In Cox regression, suboptimal BP was associated with higher composite outcome risk in univariable analysis (HR 1.86, 95% CI 1.23-2.81, p=0.003) and remained independently associated after adjustment for age, sex, NYHA II symptoms, EuroScore II, AR regurgitant volume, LVESV index, and LVMi (HR 1.75, 95% CI 1.13-2.70, p=0.012). Findings were consistent for the AVR referral outcome and using the 140/90 mmHg threshold. Conclusion: In chronic AR, 1 in 3 patients had suboptimal BP control using the 140/90 mmHg target, and 2 in 3 had uncontrolled hypertension using 130/80 mmHg. Suboptimal BP control was associated with greater LV hypertrophy and risk of adverse outcomes including progression to AVR. Further studies of BP-control strategies in AR are warranted.